Tag: Obamacare

How Republicans could quell fears over their health care bill

Posted on by Emrys Westacott

by Emrys Westacott

In early May the US House of Representatives passed (by one vote) a health care plan that is supposed to replace Obamacare. Supporters of the plan claim that it will lead to better coverage at lower cost for everyone. Unknown In the words of Paul Ryan, it will be "a better system that embraces competition and choice and actually lowers costs for patients and taxpayers." Naturally, not everyone agrees. Many fear that the plan will mean higher premiums and out-of-pocket expenses to people who are older, have pre-existing conditions, or are currently protected by Medicaid. This is why there is little chance that the plan will be approved by the senate in its present form.

At a town meeting I attended in Hinsdale, NY, Republican Congressman Tom Reed spent an hour trying to reassure skeptical constituents that these fears were unjustified. His basic argument, echoing that of House Speaker Paul Ryan, was that a market-based system which encourages competition among insurance companies will drive down costs and improve coverage.

Here, then, is the central conflict at the heart of the debate over the Republican health care plan. It is a matter of faith versus fear. On the one hand, there is the faith that competitive market forces will deliver the goods we want better than any other system. On the other hand there is the fear that the market, especially when freed from government constraints (such as the one prohibiting discrimination against people with preexisting conditions), will leave some people out in the cold.

Free markets can be very efficient economic mechanisms: just look at the astonishing array of cheap consumer goods now available. But they are also heartless, perfectly indifferent to the outcomes they produce and the sufferings of those they fail to serve. Government programs can be bureaucratic and inefficient; but they are (ideally) motivated by a concern for people's welfare. Promoting well-being and alleviating suffering is their entire purpose.

Fundamental conflicts in outlook are hard to resolve. But this clash between faith in and fear of the free market in health insurance has a fairly simple resolution. Its common name is the "public option."

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Monday, May 15, 2017

Why We Should Repeal Obamacare and not Replace It with Another Insurance Plan: Thinking Out of the Box for a Health Care Solution

Posted on by Carol A Westbrook

by Carol A Westbrook

Before you, progressive reader, quit in disgust after reading the title, or you, conservative reader, quit in disgust after reading a few more paragraphs, please hear me out. I'm proposing that we repeal Obamacare (The Affordable Care Act, ACA) but not replace it with another medical insurance program. Instead, I propose that we re-think the entire concept of how we provide health care in this country. 110126_obama_sign_health_bill_ap_605

The ACA's stated purpose is "to ensure that all Americans have access to high-quality, affordable health care." Regardless of whether or not you believe good health is a fundamental human right, it is inexcusable for an affluent, first world country like ours not to provide it for its citizens. The good health of our nation is vitally important to its success, guaranteeing as it does a capable workforce, a strong military, and a healthy upcoming generation. However, I have seen the results of Obamacare from many perspectives, including that of a physician provider in a rural community, as well as that of a personal user of both insurance and Medicare. I do not believe the ACA succeeded in meeting its objectives.

It is true that the ACA provided health care insurance for millions of Americans who didn't have it previously, expanded Medicaid for the uninsured, got rid of the pre-existing condition exclusions, allowed our grown adult children to remain on our policies longer, and started the ball rolling on electronic records. These are great results.

GTY-Obamacare2-MEM-161222_12x5_1600But the ACA also caused the cost of health insurance to skyrocket, caused many people to lose their coverage, and, for some, their jobs. It forced many small doctors' practices to close, especially in rural areas, resulting in an overall decline in the quality of care in many regions. It limited patients' choices of physicians and hospitals, separating patients from their longstanding doctors. There were no checks on health care costs, which even today continue to increase. But worst of all, it mandated that our health care would be taken out of the hands of doctors and put into the hand businessmen–the insurance companies.

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Monday, April 18, 2016

Open Your Mouth, Stick Out Your Tongue, and Say “Five”

Posted on by Carol A Westbrook

by Carol A. Westbrook

6a00d8341c562c53ef01b8d1c5ba95970c“What should I do with this?” my husband asked, as he handed me the letter. It was a Press Ganey survey asking him to evaluate a recent visit to his doctor.

In case you have never seen one, a Press Ganey survey is a multi-page questionnaire in which you asked to rate your experiences during a hospital or outpatient clinic visit, from 0 (bad) to 5 (best). The completed questionnaire is mailed to Press Ganey, which compiles and analyzes the data, and reports the results to the hospital or health care system that ordered the survey.

The survey asks questions like, “Did you have to wait long to see your doctor? Was the staff pleasant? Was the waiting room clean? Did your doctor take enough time to explain things to you? Did your doctor smile and shake your hand? Did the valet parker return your car promptly?” It also does not ask questions that the health care organization does not want to hear, for example, “Was your doctor given enough time with you? Did you actually get to see the doctor instead of the nurse practitioner? “Press Ganey has been called an Angels' List for clinics and hospitals.

That is why administrators love Press Ganey surveys–because they know that good scores will bring in more business. They also have the side benefit of providing an outlet for unsatisfied or angry patients who otherwise would be pounding on their door. Giving a doctor a “0” makes a disgruntled customer feel that he is addressing a problem, without the manager ever having to do anything about it!

Most importantly, though, patient satisfaction scores provide “objective” data that can be used to manipulate physicians by lowering their salaries or even firing them if they do not maintain a high score.

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Monday, July 2, 2012

America’s Move to the Right

Posted on by Akim Reinhardt

by Akim Reinhardt

John RobertsLast week, U.S. Supreme Court Chief Justice John Roberts stunned much of America. Normally associated with the court’s Conservative bloc, he jumped ship and cast the deciding vote in the 5-4 case of Florida v. Department of Health. His support allow the court to uphold the constitutionality of the individual mandate portion of the Patient Protection and Affordable Care Act (ACA). Popularly known as ObabaCare, the bill requires all but the poorest Americans to purchase health insurance or pay a hefty penalty.

All of Roberts’ usual compatriots, along with the court’s typical swing voter, Justice Anthony Kennedy, vigorously dissented. Not only did they claim that the mandate is unconstitutional, they wished to scrap the entire bill. Had Roberts voted with them, as most observers expected him to, ObamaCare would have gone down in flames. But he didn’t. Instead, he infuriated Conservatives and made (temporary?) friends among Liberals by allowing the bill to stand. And in order to do so, he split the difference.

On the one hand, Roberts remained true to his philosophy of judicial restraint, stating in his decision: “every reasonable construction must be resorted to, in order to save a statute from unconstitutionality.” Furthermore, he steadfastly refused to join the Liberal wing in signing off on the bill’s constitutionality under the commerce clause; Congress, he maintained, most certainly cannot compel Americans to purchase health insurance. In these respects, at least, wore Conservative garb. However, Roberts did allow that in this case, the government's fine on individuals who buck the mandate, could be interpreted as a tax. That was a particularly liberal reading of the bill, pun intended, given that for political reasons the ACA’s architects had been careful to not to call the penalty a tax. But with that reading, Roberts found a way to join the four Liberal justices in upholding the ACA since Congress’ powers of taxation are well established. Thus did Roberts craft an opinion that eased his Conservative conscience while also allowing a Liberal piece of legislation to stand.

Or did he?

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